Online Therapy: Questions and Answers

In accordance with social distancing guidelines, I am offering only telehealth therapy sessions for the time being. If you are used to therapy happening in person, the idea of video sessions might feel odd to you. If you pay attention to a few details, you can make online therapy work for you, whether you are seeking short-term counseling to manage pandemic-related stress or wanting to start therapy to address longer-term issues you’ve been thinking about for a while. Here are some questions I hear from people about telehealth or video therapy:

Isn’t video a poor substitute? While it has limitations, there are also benefits. You can have your cat with you in your session if that’s comforting. Since your therapist can’t fully see all your body language, you get the opportunity to learn how to use your words to tell someone else what is happening inside your head and body. This is important grown-up stuff that will make all your relationships better! You may be used to your therapist seeing your emotions arise before you are even aware of them (we’re not mind readers, we’re just really good at listening to nonverbal communication!). Now you may need to say things out loud like, “my foot just started tapping fast when you said that,” or “I can feel tears coming to my eyes right now.” You are now several steps closer to being able to know what you are feeling and talk about your emotions even in charged moments, which I promise your friends or romantic partners will appreciate so much more than “I don’t know” when they ask you what are feeling right now!

I feel weird about starting therapy in the midst of … all this. I get it. There’s anxiety in the air, an hour-long wait to get into the grocery store, and no toilet paper in sight. There are many people sick and dying. It feels like a crisis. It is a crisis. Therapy can help you manage your reaction to the crisis, process your grief, discern what is healthy and useful planning vs. unhealthy catastrophizing black holes of anxiety. Therapy can also help you move beyond crisis mode and invest in your long-term well-being. Those long-standing issues of perfectionism, lifelong struggles with depression, defenses that prevent you from really connecting to your loved ones? If you are not in crisis yourself, this is truly as good a time as any to work on this stuff. Possibly even a better time than usual, because the slower pace of life and increased attention to the importance of social connections means this area of your life is ripe and ready to be nourished.

What about security and privacy. Make sure your therapist is using a secure platform that can’t be hijacked or “zoombombed” by strangers. I use a secure platform, not Zoom, and I have had no security issues and very few technical glitches. Finding privacy at home can also be an issue when everyone is at home. You may need to do some pre-therapy-session planning to make sure you have the physical and emotional space you need to really focus on yourself and your vulnerable thoughts and feelings. Negotiate use of a room uninterrupted for 50 minutes. Hang a sign on the door just like your therapist does on their office. Put a white noise app on your phone or ipad, any device you aren’t using for the session, and put it by the door so people can’t hear your voice inside. If you don’t have access to a room, I’ve had clients hunker down in their parked cars, sit inside a bathroom because it is the only door with a lock, or even hang out on a bench in a secluded part of a park.

Can I afford this right now? Therapy can be expensive, and if you have lost income due to the pandemic, there are good low-cost options out there. You can also ask your therapist if they have a sliding scale option — I do, and I am always happy to discuss your individual circumstances and what we can do to make therapy fit into your budget. If you are still working through all this, you may have noticed that your expenses have gone down significantly without commuting, eating out, concerts, and other expenses. This can be a great time to invest in your mental health. Imagine yourself a few years in the future, looking back at this time. How do you want to have used this time? It’s wonderful that we are all making socializing (via video and phone) a priority, really investing and building our relationships to loved ones. Shouldn’t we also be investing in our relationships to ourselves?